Asthma is a lung disease that causes chronic inflammation in the airways, difficulty breathing, and shortness of breath. It is also associated with ankylosing spondylitis (AS). AS is an autoimmune condition that causes inflammation in the spine that, over time, can cause vertebrae to fuse together.
Here’s what to know about the connection, including how to live well with both conditions.
People with AS have an increased risk of allergy-related diseases including asthma. One study in particular found that the incidence (rate of occurrence) of asthma was 1.74 times higher in people with AS than in the general population.
Similar to the cause of spondylitis, allergic diseases like asthma result from an inappropriate or exaggerated immune system response. This response often involves immune cells known as T cells — in the case of asthma, the helper T cells known as Th2 and Th17. The levels of these helper T cells have also been found to be elevated in people with AS.
The reason for the increased risk of asthma in those diagnosed with AS is thought to be due to the increased levels of Th2 and Th17 cells found in AS. These helper T cells release cytokines — substances that signal to other cells to modulate (modify) the body’s immune response. If the helper T cells found in AS release these cytokines inappropriately, the T cells may cause asthma.
Some studies have found that having asthma puts a person at a higher or lower risk of developing an inflammatory form of arthritis called rheumatoid arthritis, although further study into this connection is needed. AS is also a rheumatic disease, so research gathered from such studies may reveal similar findings for this type of spondylitis.
Living with asthma can be stressful. Adding AS on top can be even more difficult.
Sometimes, the two conditions compound to make one of them worse. For instance, people diagnosed with AS can experience painful muscle spasms. Coughing from asthma can bring on similar painful spasms, like they did for one member, who wrote, “I’m having a lot of coughing and back spasms.” When coughing and muscle spasms happen together, you may feel worsened pain and discomfort.
Sometimes, having spondylitis and asthma together can make it hard to care for both conditions. Treatments and approaches for managing one condition might be contraindicated (advised against) for managing the other condition.
Part of managing the pain and stiffness caused by AS involves getting regular physical activity. However, asthma can cause difficulty breathing and shortness of breath. These issues can make it more difficult to get the exercise needed to help manage AS symptoms.
Similarly, some experts recommend lying on your back at night to ease symptoms of spondylitis, but this sleeping position can cause problems for people diagnosed with asthma. As one member explained, “I can’t lay flat on my back to sleep. It feels like my air is cut off.” It can be difficult to sleep in a way that is good for both asthma and AS.
Because managing asthma and AS can be a balancing act, it’s important to work closely with pulmonologists (lung doctors) and rheumatologists (doctors of the muscles, joints, and bones) who specialize in both conditions. These specialists can help you find treatments that can help improve your quality of life and overall sense of well-being.
Some asthma and spondylitis treatments can overlap, and others focus on spondylitis alone. Talk to your asthma doctor and your rheumatologist about what drugs or treatments might be best for you when dealing with both conditions.
Nonsteroidal anti-inflammatory drugs are often the first line of defense when treating AS. Although the strongest of these drugs are only available via prescription, both ibuprofen and naproxen can be purchased over the counter.
Disease-modifying antirheumatic drugs target the immune system. They help reduce the immune response that causes AS, decreasing the related pain and swelling.
Drugs in this category that have been developed more recently are called biologics. Biologics are genetically engineered proteins derived from living organisms. These drugs work by targeting specific components in the immune system that drive inflammation, including tumor necrosis factor-alpha (TNF-α).
Some antirheumatic biologics used to treat AS, such as TNF-α inhibitors (anti-TNF), can also alter levels of T cells to reduce inflammation and ease asthma symptoms. According to one study, one type of medication may help treat both conditions at the same time. This research found that a particular type of biologic (known as a humanized anti-IgE monoclonal antibody) allowed participants with asthma to decrease or stop their use of corticosteroids to control their symptoms.
Corticosteroids are an effective short-term solution for managing acute AS flares. Because corticosteroids reduce inflammation throughout the body, these drugs may improve asthma symptoms and AS symptoms.
There are several ways you can help manage symptoms of spondylitis that don’t involve taking medications. You can work with your doctor or other health care provider to determine which approaches to use alongside other AS treatments.
Physical therapy can help people with spondylitis stabilize their joints, reduce their pain, maintain their mobility, and improve strength and balance. Physical therapists help you change and adjust the ways you sit, stand, move, and more so that you don’t aggravate your AS back pain. This approach may also help reduce lower back pain and spasms from asthmatic coughing.
Regular exercise is important for managing asthma and AS, so try to find ways to fit exercise into your daily routine. Allow yourself plenty of time to take breaks and rest. Finding an activity you enjoy can be particularly helpful. If you like gardening, for example, spending even 30 minutes each day raking the yard or pulling weeds can help get you moving more regularly.
Meditation can help people who deal with chronic pain, like those diagnosed with AS, to feel better. Meditation helps with managing pain and has been found to raise perceived quality of life and sense of well-being. Meditation can also help lower stress levels, making it a powerful tool, as stress can trigger AS and asthma flares.
Deep-breathing exercises can be beneficial for both asthma and AS symptoms. Practicing breathing exercises on a regular basis may help stave off chest stiffness caused by AS and increase oxygen levels with conditions like asthma. You can try these breathing exercises recommended by the American Lung Association or see a pulmonary rehabilitation specialist for tailored exercises.
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Do you have spondylitis and asthma? Share your experience in the comments below or start a conversation on MyAsthmaTeam.